PATIENT EDUCATION
Paediatric Orthopaedic Concerns
This section is written for parents and caregivers observing changes in a child. Normal childhood development varies widely, and many of these patterns are a normal part of growing up.
Select a concern below to view more information.
Limp or Altered Gait
What you may notice
- Your child favouring one leg, or walking with an uneven rhythm.
- Reluctance to bear full weight on one leg.
- A limp that may be more noticeable after activity or at the end of the day.
- Your child asking to be carried more than usual, or avoiding running and jumping.
Typical age context
This can occur at any age. The likely causes differ considerably between toddlers, young children and older children or adolescents.
Common causes
- A minor, often unnoticed injury or muscle strain.
- A viral illness causing temporary joint irritation, most often at the hip.
- Growing bones and joints going through a phase of rapid change.
- Less commonly, a joint infection or a specific childhood hip condition.
What it could be
- Temporary joint inflammation following a viral illness (transient synovitis).
- A joint or bone infection such as septic arthritis or osteomyelitis.
- Perthes disease, typically affecting younger school-age children.
- A slipped growth plate at the hip (slipped capital femoral epiphysis), usually in older children and adolescents.
- A fracture, sometimes following a minor fall that was not clearly witnessed.
What you can do at home
- Note when the limp started and whether there was any injury.
- Observe whether it is improving, staying the same or worsening.
- Watch for fever or your child seeming generally unwell.
- Avoid forcing your child to walk normally through pain.
When to see a doctor urgently
- The limp is accompanied by fever or your child seems generally unwell.
- Your child refuses to bear any weight on the leg.
- The limp came on suddenly and severely, particularly after a fall.
- Your child appears to be in significant pain, or the leg is swollen, red or deformed.
When to see a doctor
- A limp lasting more than a few days without an obvious cause.
- A limp that keeps recurring.
- Any limp in a child too young to explain what is wrong.
In-Toeing, Out-Toeing, Bow Legs or Knock Knees
What you may notice
- Your child's feet turning inward or outward noticeably when walking or running.
- Legs that appear bowed outward or angled inward at the knees.
- Tripping more than other children the same age, in some cases.
- Family members or teachers commenting on your child's walking pattern.
Typical age context
These patterns are extremely common and are usually part of normal development. Bow legs are typical up to around age 2–3, and knock knees are typical from roughly age 3–7 before the legs settle toward adult alignment. In-toeing is also common in toddlers and often improves during early childhood.
Common causes
- Normal, expected stages of childhood leg development.
- The position or rotation of the leg bones, which often changes naturally with growth.
- A family pattern.
- Less commonly, an underlying bone or metabolic condition.
What it could be
- Normal developmental alignment that will likely self-correct with age.
- A rotational variation in the thigh or shin bone.
- Rarely, a metabolic bone condition such as rickets.
- Rarely, a skeletal growth disorder, particularly if the change is asymmetric or outside the expected age pattern.
What you can do at home
- Take photographs every few months to track change over time.
- No special shoes, braces or exercises are generally needed for normal developmental variations.
- Mention the concern during routine check-ups even if you are not especially worried.
When to see a doctor urgently
- Sudden onset of significant bowing or angulation, particularly with pain.
- Bowing or angulation following an injury.
When to see a doctor
- The alignment is asymmetric, with one leg clearly different from the other.
- Bowing or knock knees are severe, worsening or persisting well beyond the typical age range.
- Your child is also short for their age or you have concerns about growth or diet.
- Pain accompanies the alignment change.
Growing Pains / Night Limb Pain
What you may notice
- Aching pain in the legs, often in the calves, shins or behind the knees.
- Pain that usually occurs in the evening or wakes your child at night.
- Pain that is usually gone by morning, with normal movement the following day.
- Pain affecting both legs, often on different nights rather than consistently on one side.
Typical age context
Growing pains are most common between approximately 3 and 12 years of age.
Common causes
- Growing pains — a benign pattern of limb discomfort common in active children.
- A particularly busy or active day involving running or prolonged standing.
- Rarely, an underlying joint, bone or blood condition when the pattern is atypical.
What it could be
- Typical growing pains when both legs are affected, symptoms occur at night and daytime activity remains normal.
- Overuse-related muscle ache following an active day.
- Less commonly, a joint condition or infection when pain is one-sided, persistent or accompanied by limping, swelling or fever.
What you can do at home
- Gentle massage of the affected area.
- A warm compress before bed.
- Reassurance when the pattern is typical.
When to see a doctor urgently
- Pain is one-sided and persistent rather than following the typical alternating pattern.
- Pain occurs during the day and affects your child's activity.
- Pain is associated with limping, swelling, fever or your child appearing generally unwell.
- Pain wakes your child and does not settle with comfort measures.
When to see a doctor
- You are unsure whether the pattern fits typical growing pains.
- The pain regularly affects your child's sleep.
- You would simply like reassurance.
Delayed Motor Milestones
What you may notice
- Your child not sitting, crawling, standing or walking within broad typical age ranges.
- Movement that looks different from other children the same age.
- Unusual crawling patterns or persistent toe-walking.
- Your child appearing to lag behind siblings at the same age.
Typical age context
Rough general guides include sitting without support at around 6–9 months, crawling at approximately 7–10 months, and independent walking at around 12–18 months. The normal range is wide and every child develops at an individual pace.
Common causes
- Normal developmental variation.
- Reduced opportunities for supervised floor time or movement practice.
- Prematurity, where expectations are usually adjusted for corrected age.
- Less commonly, an underlying neuromuscular, developmental or orthopaedic condition.
What it could be
- Normal developmental variation, particularly if your child is otherwise progressing steadily.
- A muscle tone or neuromuscular difference affecting movement.
- A hip or lower-limb condition affecting comfortable movement.
- Rarely, a broader developmental condition.
What you can do at home
- Encourage supervised floor time and age-appropriate movement practice.
- Keep a simple record of what your child can and cannot yet do and how this changes over time.
- Discuss concerns during routine well-child checks.
When to see a doctor urgently
- Loss of a skill your child previously had.
- Delay accompanied by marked floppiness, stiffness or asymmetry between the two sides of the body.
When to see a doctor
- Your child is significantly behind the typical range for a milestone.
- Several areas of development appear delayed, not only movement.
- You have a persistent concern that something is not right.
Limb Length or Symmetry Concerns
What you may notice
- One leg or arm appearing visibly longer or shorter than the other.
- Uneven trouser hems or shoe wear between the two sides.
- A tilt of the hips while standing or a limp that seems related to leg length rather than pain.
- Persistent asymmetry in how your child sits, crawls or moves.
Typical age context
Limb asymmetry can be noticed at any age, from infancy through adolescence. The underlying cause and importance depend on when it first appears and how it changes as the child grows.
Common causes
- Minor functional differences caused by posture or muscle tightness.
- A true difference in bone length, present from birth or developing over time.
- A previous fracture that affected growth on one side.
- A hip condition affecting one side more than the other.
What it could be
- A functional or postural difference rather than a true limb-length difference.
- A true structural limb-length discrepancy ranging from minor to more significant.
- Developmental dysplasia of the hip, particularly relevant in infants.
- A growth-plate injury affecting subsequent bone length.
What you can do at home
- Note when the asymmetry was first noticed and whether it appears to be changing.
- Take photographs periodically to help document change over time.
- Avoid attempting to correct the difference yourself with shoe inserts before formal assessment.
When to see a doctor urgently
- Asymmetry that appeared suddenly, particularly with pain or following injury.
- Asymmetry accompanied by a limp and fever or your child appearing unwell.
When to see a doctor
- Any suspected true limb-length difference for accurate measurement and monitoring.
- Uneven hips while standing or persistent asymmetric movement.
- In infants, any hip asymmetry noticed during routine care, even if previous screening was reported as normal but concerns remain.
YOUR CHILD'S CONSULTATION
What to Expect at Your Visit
- The doctor will ask about your child's overall development, when the concern was first noticed and any relevant birth or family history.
- Your child will be examined for gait, joint movement, alignment and muscle strength in an age-appropriate and unhurried way.
- Growth measurements may be plotted on a growth chart, because the pattern of growth over time often provides more information than a single measurement.
- Imaging, when necessary, is usually an X-ray. Blood tests may be added if a metabolic or inflammatory cause is being considered.
- Many childhood orthopaedic concerns are normal variations of development. An important part of the consultation is distinguishing these from the smaller number of conditions that require monitoring, investigation or specialist treatment.
* IMPORTANT: A Note Before You Go
Childhood growth and development vary considerably from one child to another. Many of the patterns described on this page are normal variations that improve naturally with growth.
This information is intended to help parents and caregivers understand common paediatric orthopaedic concerns. It cannot diagnose your child or replace an individual medical assessment. If you are concerned about your child's pain, development, walking pattern or limb alignment, it is appropriate to have them examined.